Penfold, Sarah, St Denis, Emily, Mazhar, Mir Nadeem · BJPsych open · 2016 · DOI
This review examined whether borderline personality disorder (BPD)—a mental health condition affecting emotions and relationships—occurs more often in people with ME/CFS or fibromyalgia than in the general population. The researchers found that BPD appeared in roughly 2-17% of ME/CFS patients and 1-17% of fibromyalgia patients across different studies, but the numbers varied widely. The authors concluded that more research is needed to understand whether these conditions are truly connected.
Understanding comorbidity patterns between ME/CFS and psychiatric conditions like BPD is important for improving diagnosis and avoiding misattribution of symptoms to psychiatric causes alone. This review highlights a significant gap in the literature and suggests that future research should rigorously investigate whether these conditions share biological pathways, are independently coincident, or are subject to diagnostic bias.
This study does not establish causation, directionality, or a true biological association between BPD and ME/CFS. The wide variation in prevalence estimates (1.8–17% for CFS) across studies suggests methodological differences in diagnostic criteria and populations that prevent firm conclusions. The absence of studies examining BPD patients for ME/CFS/fibromyalgia prevalence means we cannot determine whether any observed comorbidity is bidirectional.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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Primary citation
Penfold, Sarah, St Denis, Emily, & Mazhar, Mir Nadeem (2016). The association between borderline personality disorder, fibromyalgia and chronic fatigue syndrome: systematic review.. BJPsych open. https://doi.org/10.1192/bjpo.bp.115.002808
BibTeX
@article{mecfsatlas-penfold-2016-association-between,
author = {Penfold, Sarah and St Denis, Emily and Mazhar, Mir Nadeem},
title = {The association between borderline personality disorder, fibromyalgia and chronic fatigue syndrome: systematic review.},
journal = {BJPsych open},
year = {2016},
doi = {10.1192/bjpo.bp.115.002808},
note = {PubMed: 27703787},
url = {https://www.mecfsatlas.com/evidence/penfold-2016-association-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/penfold-2016-association-between
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